'Scarless' Flap Provides New Alternative for Breast Reconstruction

PHILADELPHIA — An innovative "scarless" flap technique provides a new option for breast reconstruction, with a shorter operative time and lower complication rate compared to a traditional flap design, suggests a report in Plastic and Reconstructive Surgery—Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).

Developed by Australian plastic surgeons, the scarless latissimus dorsi flap is a safe and versatile alternative for breast reconstruction after mastectomy. It may be particularly appropriate for women undergoing prophylactic mastectomy to reduce breast cancer risk, according to the paper by Dr. Mark A. Lee of St John of God Hospital, Subiaco, and Kirstin G. Miteff of Royal Perth Hospital, Perth, Western Australia.

From 2009 to 2012, Dr. Lee used the scarless latissimus dorsi flap for 30 breast reconstructions in 20 women. It's not a new idea to use flaps based on the latissimus dorsi muscle—the largest muscle of the back—for breast reconstruction.

What's new is the approach to accessing the latissimus dorsi without the need for an additional incisions on the back—or two incisions, if both breasts are being reconstructed. Although it's not literally "scarless," the new flap design avoids scars, pain, and possible complications related to the additional incisions.

In Dr. Lee's experience, operative time was about one hour shorter using scarless reconstruction, compared to 20 women undergoing reconstruction with traditional latissimus dorsi flaps. This contributed to a reduced complication rate: about one-fourth lower than in the traditional group. Women undergoing scarless reconstruction also went home from the hospital about a day and a half earlier.

Alternative to Reconstruction Using Acellular Dermal Matrix?

Modern surgical techniques provide good "oncologic control" of breast cancer while preserving much of the woman's own breast tissue for use in immediate reconstruction. A biomaterial called acellular dermal matrix (ADM) is a popular new option for immediate reconstructions.

While ADM has some advantages—especially in avoiding the need for skin flaps—it is expensive and carries a risk of potentially serious complications. In addition, because of its high cost and need for special training and equipment, ADM isn't available everywhere.

Drs. Lee and Miteff believe the scarless latissimus dorsi flap provides a useful alternative to the use of ADM, including settings where ADM isn't available or practical for use. The open access format of PRS GO allows the authors to present and illustrate their technique in detail to a global audience.

Immediate reconstruction is also performed in women at high genetic risk undergoing mastectomy to prevent breast cancer. The researchers believe that the scarless technique may offer "great advantage" for this rapidly growing group of young patients.

In another significant benefit, the scarless technique eliminates the need to turn the patient during anesthesia, which is necessary to obtain the traditional latissimus dorsi flap. This contributes to the shorter operative time, helping to use the plastic surgeon's time more efficiently.

"This method of breast reconstruction is relatively time effective, requires no patient repositioning, and uses standard breast instruments," Drs. Lee and Miteff conclude. Further evaluation—including comparison with reconstructions using ADM—will be needed to determine the role of the scarless latissimus dorsi flap in modern approaches to breast reconstruction.

Plastic and Reconstructive Surgery—Global Open® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About PRS Global Open

Plastic and Reconstructive Surgery—Global Open (PRS GO) is a companion journal to the American Society of Plastic Surgeons’ flagship publication, Plastic and Reconstructive Surgery. PRS GO is an open access, rigorously peer-reviewed, international journal focusing on global plastic and reconstructive surgery. PRS GO educates and supports plastic surgeons globally to provide the highest quality patient care and maintain professional and ethical standards through education, research, and advocacy.

About Wolters Kluwer Health

Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health’s customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.